SM184 Anovulation Flashcards
Define amenorrhea
Menses > 6 months
Define oligomenorrhea
Menses 35 days - 6 months
Most common cause of secondary amenorrhea
Pregnancy
Effect of breast feeding on menstruation
Prevents it
What hormone in contraceptives cause amenorrhea?
Progestin (synthetic progesterone) in OCPs, progestin-only pill, progestin injections, implants, and IUDs
Induces endometrial atrophy
Most common endocrine disorder in women
PCOS
FSH functions
Stimulates granulosa cell proliferation
Stimulates aromatase and estradiol
Increases granulosa cell FSH and LH receptors
Produces autocrine-paracrine factors, especially activin and inhibin
What causes LH surge?
Estradiol positive feedback
Hypogonadotropic hypogonadism
Stress, weight loss, and exercise
Low/normal FSH and LH
Hypoestrogenic
Thin endometrial stripe, failure to withdraw to progestins, immature vaginal cytology, low estradiol level
Hypogonadotropic hypogonadism treatment
Lifestyle modification
Ovulation induction with human menopausal gonadotropins with LH and FSH
Hyperprolactinemia
Most common pituitary cause of secondary amenorrhea
Check TSH to rule out hypothyroidism
Pregnancy/breast feeding
Drug history
MRI
Drugs that induce hyperprolactinemia
Antipsychotics: phenothiazines, haldoperidol, clozapine, olanzapine, risperidone
PCOS
Androgen excess (hirsutism, acne), insulin resistance, anovulation
Ovary with 12 or more follicles 2-9 mm in diameter
PCOS treatment
Anovulation: OCP, SERMs (clomiphene citrate), aromatase inhibitors (letrozole anastrozole), gonadotropin injections
Hirsutism: OCP and spironolactone
Insuline resistance: OGTT, weight loss, metformin
Premature ovarian failure
Menopause before 40
Two FSH levels > 40 one month apart
Treatment: oocyte donation
Fragile-X pre-mutation
15% have primary ovarian failure
POF genetic testing
Karyotype: under age 30 or less than 60” (look for Turner or mosaics)
Fragile-X analysis in all under 40
Asherman’s syndrome
Trauma to the basal layer of the uterus, usually following a D&C
No breast development + uterus present
FSH high: gonadal dysgenesis
FSH low: hypogonadotropic hypogonadism
Breast development + uterus present
XX: congenital absence of the uterus (Mayer-Rokitansky-Kuster-Hauser)
XY: androgen insensitivity syndrome
No breast development + no uterus
Rarest primary amenorrhea
Karyotype: 46XY
LH receptor mutation, 17,20-lyase deficiency
Breast and uterus present: normoestrogenic
Androgen excess: PCOS
Normal androgens: atypical PCOS, mild hypogonadotropic hypogonadism
Breast and uterus present: hypoestrogenic
Low FSH: hypogonadotropic hypogonadism
High FSH: POF
